Targeted treatment of primary aldosteronism – The consensus of Taiwan Society of Aldosteronism

Chang, Chin Chen; Chan, Chieh‐Kai; Wu, Vin‐Cent; Lin, Jui-Hsiang; Wang, Weijie; Wu, Che‐Hsiung; Hu, Yahui; Er, Leay Kiaw; Chang, Chia‐Hui; Chang, Yuan; Tsai, Yao‐Chou; Yu, Chih-Chin; Lin, Yen‐Hung; Ho, Yen Teng; Chang, Hung-Wei; Lin, Lian‐Yu; Hu, Fu‐Chang; Chang, Chin‐Chen; Liu, Kao–Lang; Wang, Shuo-Meng; Huang, Kuo‐How; Chueh, Shih-Chieh; Liao, Shih‐Cheng; Lu, Ching‐Chu; Yen, Ruoh‐Fang; Wu, Kwan‐Dun

doi:10.1016/j.jfma.2018.01.006

Cited by 22 publications

(18 citation statements)

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“…Among them, three were clinical practice guidelines, and three were consensus statements. These included the Endocrine Society Clinical Practice Guideline (2016) (10), the Chinese practice consensus on the diagnosis and treatment of PA (Chinese Endocrine Society, 2016) (11), the Japan Endocrine Society guideline (2011) (12), the consensus of the Taiwan Society of Aldosteronism (2009 and 2011) (19,20), the Clinical Management of PA by the Italian Society of Hypertension (2014) (21), and the SFE/SFHTA/AFCE consensus on PA (2016) (22)(23)(24)(25)(26)(27)(28).…”

Section: Resultsmentioning

confidence: 99%

The Quality of Clinical Practice Guidelines and Consensuses on the Management of Primary Aldosteronism: A Critical Appraisal

et al. 2020

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Background: Several guidelines and expert consensuses have been developed for management of primary aldosteronism (PA). It is important to understand the detailed recommendations and quality of these guidelines to help physicians make informed and reliable decision. Methods: PubMed, EMBASE, and three websites were searched for practice guidelines or consensuses of PA from inception to January 24, 2019. We summarized the major recommendations on the management of PA from these guidelines and consensuses. The Appraisal of Guidelines for Research and Evaluation II was used to assess quality of the included guidelines and consensuses. Results: We identified three clinical practice guidelines and three consensus statements. Most of the recommendations on the diagnosis and treatment of PA from these guidelines and consensuses were consistent. Some minor conflicts were recorded for patient's screen and confirmation test. All included guideline documents have a good quality (score, >70%) on the scope and purpose (mean score, 81.02%) and clarity of presentation of the recommendations (mean score, 86.88%). However, the reporting for the stakeholder involvement (mean score, 54.32%) and applicability (mean score, 47.92%) were insufficient. There was an insufficient rigorousness in most of the guideline documents (mean score, 45.56%) on the development process. The Endocrine Society practice guideline 2016 ranked highest in quality (score, 81.13%). Conclusions: Existing guideline documents provided valuable recommendations on the management of PA, but further efforts are needed to improve the methodological quality. The Endocrine Society practice guideline 2016 was recommended for use.

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Section: Resultsmentioning

confidence: 99%

The Quality of Clinical Practice Guidelines and Consensuses on the Management of Primary Aldosteronism: A Critical Appraisal

et al. 2020

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“…Although adrenalectomy is currently considered as the standard treatment in lateralized PA patients (9,12,13), some patients might have residual hypertension and still need antihypertensive medications after surgery. The current practice guideline recommends adrenalectomy for lateralized aldosterone excess (9,12), whereas bilateral disease is treated using MRA (9,14). However, there are still some patients with lateralized disease who do not undergo surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

Composite Cardiovascular Outcomes in Patients With Primary Aldosteronism Undergoing Medical Versus Surgical Treatment: A Meta-Analysis

et al. 2021

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BackgroundSuperior outcomes after surgical treatment over medical treatment for primary aldosteronism (PA) has been reported in small-scale clinical studies, but no solid conclusion has been drawn as results of large randomized trials are lacking.MethodsWe performed a search of PubMed, MEDLINE, Embase and Cochrane Library for randomized or observational studies that investigated cardiovascular outcomes in patients with PA undergoing medical versus surgical treatment. Meta-analyses of both composite and individual outcomes were conducted. Risks of bias of the included studies were assessed with Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) checklist. Trial sequential analysis (TSA) was performed to control the risk of random errors and assess whether the results in our meta-analysis were conclusive.ResultsA total of 12 studies, including a total of 6148 PA patients, were included in the meta-analysis. The results of meta-analyses demonstrated lower incidence of composite cardiovascular outcomes among PA patients who underwent surgical treatment over medical treatment (odds ratio (OR): 0.49). Surgical treatment also led to less incidence of persistence of hypertension (OR of non-cure hypertension: 0.31). Fewer major cardiovascular events and mortality events were observed (OR: 0.60) after surgical treatment. TSA result showed that the required information size was 2151 and the cumulative Z curve crossed the futility boundary and reached the required information size.ConclusionSuperior performance of surgical treatment over medical treatment is confirmed with meta-analyses in terms of lower incidences of composite cardiovascular outcomes and non-cure of hypertension. Hence, adrenalectomy could now be concluded as the treatment of choice for lateralized PA.

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“…Second, PA patients had significantly higher risk of cardiovascular events, diabetes and metabolic syndrome as compared with patients with essential hypertension ( 3 ). Third, PA is controllable and even curable through proper treatment, by means of mineralocorticoid antagonist for bilateral disease and adrenalectomy for unilateral disease ( 4 ). John W Funder has stated that PA is a public health issue on the basis of prior mentioned concerns and underlying great impact on medical care resources ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

NP-59 Adrenal Scintigraphy as an Imaging Biomarker to Predict KCNJ5 Mutation in Primary Aldosteronism Patients

Yen

Peng

et al. 2021

Front. Endocrinol.

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PurposeSomatic KCNJ5 mutation occurs in half of unilateral primary aldosteronism (PA) and is associated with more severe phenotype. Mutation status can only be identified by tissue sample from adrenalectomy. NP-59 adrenal scintigraphy is a noninvasive functional study for disease activity assessment. This study aimed to evaluate the predictive value of NP-59 adrenal scintigraphy in somatic KCNJ5 mutation among PA patients who received adrenalectomy.MethodsSixty-two PA patients who had NP-59 adrenal scintigraphy before adrenalectomy with available KCNJ5 mutation status were included. Two semiquantitative parameters, adrenal to liver ratio (ALR) and lesion to contralateral ratio of bilateral adrenal glands (CON) derived from NP-59 adrenal scintigraphy, of mutated and wild-type patients were compared. Cutoff values calculated by receiver-operating characteristic (ROC) analysis were used as a predictor of KCNJ5 mutation.ResultsTwenty patients had KCNJ5 mutation and 42 patients were wild type. Patients harboring KCNJ5 mutation had both higher ALR and CON (p = 0.0031 and 0.0833, respectively) than wild-type patients. With ALR and CON cutoff of 2.10 and 1.95, the sensitivity and specificity to predict KCNJ5 mutation were 85%, 57% and 45%, 93%, respectively. Among 20 patients with KCNJ5 mutation, 16 showed G151R point mutation (KCNJ5- G151R) and 4 showed L168R point mutation (KCNJ5-L168R), which former one had significantly lower ALR (p=0.0471).ConclusionPA patients harboring somatic KCNJ5 mutation had significantly higher NP-59 uptake regarding to ALR and CON than those without mutation. APAs with KCNJ5-L168R point mutation showed significantly higher ALR than those with KCNJ5-G151R point mutation.

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Targeted treatment of primary aldosteronism – The consensus of Taiwan Society of Aldosteronism

Abstract: We hope this consensus will provide a guideline to help medical professionals to manage PA patients in Taiwan to achieve a better quality of care.

Cited by 22 publications

References 85 publications

The Quality of Clinical Practice Guidelines and Consensuses on the Management of Primary Aldosteronism: A Critical Appraisal

The Quality of Clinical Practice Guidelines and Consensuses on the Management of Primary Aldosteronism: A Critical Appraisal

Composite Cardiovascular Outcomes in Patients With Primary Aldosteronism Undergoing Medical Versus Surgical Treatment: A Meta-Analysis

NP-59 Adrenal Scintigraphy as an Imaging Biomarker to Predict KCNJ5 Mutation in Primary Aldosteronism Patients

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